HIV and AIDS

Pamela Nash Excerpts

Tuesday 10th December 2013 Westminster Hall

[Pamela Nash (Airdrie and Shotts) (Lab)]

It is a pleasure to open this debate and to see you in the Chair, Mr Dobbin. I thank Mr Speaker for granting us the debate and my colleagues for attending this morning. Many of them have shown great support to the all-party group on HIV and AIDS, which I have chaired for two and a half years.

I am happy to see my hon. Friend the Member for Wirral South (Alison McGovern), in her newish role as shadow International Development Minister. I am also happy to see the Minister in attendance this morning; she has a strong personal commitment to the HIV response and has demonstrated that throughout her time at DFID. She has championed both the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNAIDS, overseeing a significant increase in funding to both, which the all-party group has been delighted to see.

Today’s debate is timely, not just because we recently commemorated world AIDS day, but because today is international human rights day. As we mourn Nelson Mandela, we remember him as one of the great advocates of the AIDS response. He summed up the challenges very aptly when he said:

“AIDS is no longer just a disease; it is a human rights issue.”

The universal declaration of human rights states:

“Everyone has the right to a standard of living adequate for the health and well-being of himself…including…medical care”.

The virus has so far infected 58 million people, become the sixth biggest killer in the world and left 1.6 million people dead in the past year alone. However, it is not just the scale of the epidemic that makes it a human rights issue. It is a human rights issue because its effect on a country is dependent on that country’s wealth, and an individual’s social status still determines their risk of being infected and their ability to access treatment if they are.

HIV is the sixth biggest cause of death in the world, but it is the second biggest in low-income countries and does not even feature in the top 10 causes of death in high-income countries. The 1.6 million people did not die of AIDS last year because treatment does not exist; they died because the medicines were too expensive for them to buy, or because the stigma was too much for them to seek help in time. AIDS and poverty are now mutually reinforcing negative forces in many developing countries. We are 30 years into the epidemic, and AIDS is sadly still a major health and human rights issue, despite the leaps and bounds in progress we have made on prevention, testing and treatment.

One of the main barriers to fighting the epidemic, which stubbornly remains, is stigma. Last year, I took part in a Voluntary Service Overseas placement in Kenya to help parliamentarians and civil society there to strengthen their own all-party group on HIV and AIDS in the Kenyan Parliament. As part of that, I was lucky to work closely with Llina Kilimo MP, a much respected politician and campaigner on HIV and women’s rights. I remember her telling me that no one dies of AIDS. I was confused for a few seconds, but then realised that she meant that no one talks about dying of AIDS. When someone dies of AIDS in Kenya, the family will usually announce the cause of death as the secondary illness that was brought on by AIDS. Owing to the stigma attached, they keep their status quiet.

The best known example of that comes from Nelson Mandela’s own family. When his daughter-in-law passed away at the age of just 46, it was announced that she had died of pneumonia. It was not until her husband, Mandela’s son, died just a couple of years later that Mandela took the brave decision to announce to the world that his son had died of AIDS. In the midst of huge personal tragedy, burying his own son, he decided to use the occasion to show leadership on an issue that he feared would destabilise his country and damage the progress he had made in South Africa. He said at the time:

“That is why I have announced that my son has died of AIDS…Let us give publicity to HIV/AIDS and not hide it, because the only way to make it appear like a normal illness like TB, like cancer, is always to come out and say somebody has died because of HIV/AIDS, and people will stop regarding it as something extraordinary for which people go to hell and not to heaven.”

Mandela had already established his well known campaign 46664—named after his prisoner number on Robben island—a couple of years before he knew of his son’s HIV status. The campaign aimed to raise not just money but awareness, to get people talking about HIV and AIDS and to attempt to alleviate the stigma that too often stops people from seeking the treatment they need. Although there has been progress since Mandela’s landmark press conference in his garden following his son’s death in 2005, I fear that the stigma attached to HIV still prevails in Africa and across the world.

Mandela’s great work is not over. People are still dying from a preventable disease, and there are still 16 million people living with HIV without access to the treatment they require. We know that women, children and socially excluded groups are the people most affected by HIV, but one of the reasons for that is that they are least likely to have a political voice and are therefore not paid enough attention.

That might seem an odd statement, given the attention paid to the issue on world AIDS day recently, and the fact that many non-governmental organisations and some of the biggest ever global campaigns and organisations now provide treatment. However, we are fighting a losing battle for the political will to end AIDS in some of the countries most at risk, because of the stigma attached—not to being HIV-positive, but to talking about the matter at all.

The project in Kenya that I have mentioned was a follow-up to one carried out by my predecessor as chair of the all-party group, David Cairns, in Kenya two years previously. He helped the National Empowerment Network of People living with HIV/AIDS in Kenya— an umbrella organisation for HIV support groups—to set up an all-party group on HIV with Kenyan parliamentarians. However, that all-party group had not quite taken off.

When I was asked to go, I was concerned about the impact I could make; if David could not make a difference and set that group up, I did not see how I could. Surely, in a country as badly affected by HIV as Kenya, MPs would be falling over themselves to join a group that campaigned on it; it must be one of the biggest issues for their constituents. However, I found that HIV was not far up the political agenda—even just before the general election, when I was there.

What I am saying is not a criticism of the Kenyan Government, who have in many ways been at the forefront of the AIDS response, but politicians were not discussing HIV as a major issue for Kenya or talking about the next steps of their response to it as part of the general election campaign. With a few notable and brave exceptions, candidates and politicians told me privately that they did not feel they could speak about HIV. They were worried that the sensitive issues of HIV prevention would put voters off. A couple said that they were worried that voters would think that they were HIV-positive, and that that would damage their chances of being elected.

[Sir Peter Bottomley (Worthing West) (Con)]

In South Africa, when senior judge Edwin Cameron said he was living with HIV/AIDS, it became possible for a number of people in representative positions to be rather more open. There are also HIV choirs in townships around Cape Town. Those developments show that a way is beginning to be found of getting what everyone knows into the open. If things are brought out from behind the curtain, it is easier for people to take the action that will reduce the spread of HIV/AIDS, and there can be greater acceptance of people with the condition.

[Pamela Nash]

I completely agree. The problem is not unique to Kenya. In fact, I spoke at last year’s international AIDS conference in Washington, where I shared a platform with Ryuhei Kawada, who is a member of the Japanese House of Councillors. I believe that he is the first politician elected while openly being HIV-positive; I know that some have revealed their status later, but he was elected having already revealed his status. At last year’s event, he spoke passionately about his hope that he would be the first of many and that others would follow in his footsteps to try to relieve the stigma around HIV. It is clear that we need more public figures to reveal their status, but it is a big ask.

Let me be clear that the news is not all bad. I did not come here to spread doom and gloom. Truly excellent progress has been made in the global fight against HIV. I do not want to bore or bamboozle Westminster Hall with stats, but four recent figures from UNAIDS highlight the success so far. There has been a 33% decrease in new HIV infections since 2001, a 29% decrease in AIDs-related deaths since 2005, a 52% decrease in new HIV infections among children since 2001 and a fortyfold increase in access to antiretroviral therapy between 2002 and 2012. That last figure, in particular, is astonishing and shows just how far we have come. Such achievements should be applauded.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I congratulate the hon. Lady on securing this debate and on all her work. It is so important to keep ensuring that HIV is a priority in the world. Does she agree that, when countries have a high incidence of co-infection, it is important to have joint programmes to control TB and HIV/AIDS?

[Pamela Nash]

I completely agree. I believe that colleagues will touch on that subject today, so I will not go into much depth, but it is something that my all-party group has worked on along with the all-party group on global tuberculosis. I hope that the hon. Lady will join in with such campaigns in future.

We cannot get carried away with progress, however. Many good news stories exist, but we have not yet reached our goal of ending the epidemic, the very nature of which means that we must continually work to eradicate HIV; if we do not, all our efforts will be overturned as it spreads further and further.

I am delighted that the Government have increased funding to the key multilateral organisations that fight AIDS. I congratulate the Minister on her role in achieving that, but I must highlight a few areas where the Government could and should be doing more. Strategies to combat the HIV epidemic are intrinsically linked to each country’s human rights environment.

Young people aged between 15 and 24 account for 45% of all new infections, according to the United Nations Commission on Human Rights. Two recent studies of women in Uganda and South Africa found that those who had experienced intimate partner violence were 50% more likely to have acquired HIV than those who had not experienced such violence. A study conducted in Malawi by the Salamander Trust, which works closely with the all-party group, revealed that women living with HIV were terrified that they would face violence if they told their partner or family about their status. Men who have sex with men are also particularly vulnerable, partly because of punitive laws in many countries.

Likewise, failure to provide access to education and information about HIV and AIDS treatment and care and support services further fuels the epidemic. I know that the Minister agrees that those elements are essential components of an effective response, but what does the Department for International Development plan to do specifically to ensure that human rights are at the heart of the HIV response?

One way is to invest in grass-roots community groups. One organisation that is particularly in my and others’ hearts is Sexual Minorities Uganda—SMUG. Members will remember the tragic murder of its leader, David Kato, in 2011. David Cairns met David Kato during a visit to Uganda, and I remember him being deeply pained at his death.

To honour both the memory of David Cairns and the heroic bravery of David Kato in his fight against prejudice, the David Cairns Foundation donated a staggering £10,000 to SMUG to help to establish Uganda’s first health care clinic specifically for the LGBT community in Kampala. It is projects such as that that will sustain the AIDS response in a country where homosexuality is criminalised. The most vulnerable populations need a place to get tested and treated without fear of imprisonment or death.

I was pleased to see that DFID will be giving £4 million to the Robert Carr Fund for Civil Society Networks, a vital organisation that reaches global and regional civil society networks. Although such funding is, of course, positive and given that civil society activism will be the backbone of the sustainable response to HIV/AIDS, will DFID be doing more for grass-roots organisations?

I am cutting my speech short as I was not expecting such an attendance this morning and a few hon. Members want to speak, but I want briefly to discuss carers. HIV affects the human rights of not only those living with it, but also those who care for the ill and the orphaned. That effect impacts disproportionately on the poorest and most vulnerable in society. In 2005, Nelson Mandela said:

“Women don’t only bear the burden of HIV infection, they also bear the burden of HIV care. Grandmothers are looking after their children. Women are caring for their dying husbands. Children are looking after dying parents and surviving siblings.”

In sub-Saharan Africa, an estimated 90% of care for people living with HIV is done in the home by family or community-based carers. Voluntary Service Overseas highlights that inequality between women and men continues to fuel the pandemic. What is DFID doing to encourage the Governments with whom it works in partnership to adopt policies that recognise the contribution of home-based carers affected by HIV/AIDS?

I want to touch on harm reduction. I do not have the time to go into it in much depth, but I want to mention the upcoming United Nations General Assembly special session on drugs in 2016. Concerns have been raised with me that harm reduction practices for injecting drug users could be affected by the special session. The UK has historically shown great leadership in harm reduction over the years and in reducing the impact of HIV on injecting drug users. Would DFID therefore consider calling for a cross-Whitehall working group in the lead up to the 2016 special session, to ensure that the UK maintains its strong leadership on harm reduction policies across the world and that nothing happens to jeopardise it?

Before I conclude, I want to touch on a future challenge for the global response to HIV—access to medicines. I was pleased that DFID carried out a review of its position paper on HIV and AIDS. The review is more than twice the size of the original paper and is testament to the Minister’s and the Department’s commitment to the issue. I remain concerned, however, that it is missing some key elements.

I am particularly concerned about access to antiretroviral treatment. Those who have been here longer than me will know that that was a focus of the all-party group long before I became an MP, with the group conducting an inquiry in 2009 resulting in a report titled “The Treatment Timebomb”. The report effectively laid out the case that people living with HIV are now living longer—thankfully—but that the cost of treatment will therefore continue to rise to levels unaffordable for many unless something is done to ensure that intellectual property rights and patents do not infringe on a person’s right to health.

I appreciate that that presents a complex challenge to Governments throughout the world. DFID’s review mentions the challenge, but the little attention given does not reflect the magnitude of the issue. Without affordable medicines, the AIDS response could not have existed and most certainly would not be sustainable in future. Will the Minister tell us what steps DFID will be taking to tackle this fundamental human rights issue of access to medicines for HIV patients? Has she had discussions with other Departments that might have influence?

Rhetoric on HIV in recent years has spoken much of the end of AIDS being within our grasp—we have the means to do it. However, although it is true that we can now prevent people from being infected and that we can treat people living with HIV so that in practice they live a full life span, we are a long way off achieving the end of AIDS.

Recently, I spoke at the annual general meeting of Stop AIDS, which is a fantastic organisation working to secure the global response to HIV and AIDS. At the AGM, the non-governmental organisation ONE reported that we are getting close to a tipping point in the epidemic, which it defined as the total number of people newly infected by HIV being equal to, and eventually lower than, the number of HIV-positive people newly put on ARVs. That is truly excellent news, which demonstrates that we are on the right track to end AIDS, although we cannot be complacent.

We are still off track on some key millennium development goals for treatment and prevention. Funding is insufficient to control and ultimately defeat the disease. Much work remains to be done and, as we approach a new global architecture in the post-MDG framework, it is vital that that is recognised by the UK and other countries that lead the way in development.

To conclude, I reiterate that HIV is not only a medical issue, but a social and a human rights one. It is one of our key human rights concerns today. I look forward to hearing the contributions of my colleagues and the Minister’s response.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for International Development (Lynne Featherstone)]

It is a pleasure to serve under your chairmanship, Mr Dobbin. I congratulate the hon. Member for Airdrie and Shotts (Pamela Nash) on securing this important debate so soon after world AIDS day and just after the Global Fund to Fight AIDS, Tuberculosis and Malaria replenishment last week. I congratulate her on the important work that she does as chair of the all-party parliamentary group on HIV and AIDS, and on her powerful contribution to today’s debate, which was truly excellent. All who have contributed are part of the cohort who go out and fight the fight against HIV/AIDS because, as hon. Members have emphasised, it is such an important and ongoing cause.

When I came into post, I made HIV/AIDS one of my top priorities. When I was shadow International Development Minister—the post now occupied by the hon. Member for Wirral South (Alison McGovern)—I went to South Africa with Business Action for Africa, along with a Labour and a Conservative Member of Parliament, to look at AIDS projects. During that visit, we went into the townships around Johannesburg and saw the conditions there. The trip had a profound effect on me. Many hon. Members have raised the phenomenal work done by Nelson Mandela. I was in South Africa at a time when the treatment for HIV/AIDS recommended by the country’s leadership was to take a shower. We can see the effect of Nelson Mandela’s work from the way in which things have changed and the amount of Government-funded work that now takes place.

When I visited South Africa, only the big corporations such as SABMiller and Anglo American provided facilities for their own employees, and they did so to stop them dying, not from pure altruism. Many hon. Members have spoken of the stigma associated with HIV/AIDS. I went into a hospital built by Anglo American where people came forward and declared their HIV-positive status in front of other members of staff. That gave those members of staff, who were afraid of the associated stigma, the courage to declare themselves and ask for testing. That was one of the most moving experiences of my life. I say to all who take MPs on trips to enlarge, inform and develop them that that trip, eight years ago, may have been a reason why I made HIV/AIDS one of my priorities when I came into office. In addition, I grew up in an era when HIV/AIDS first became an issue. Being terrified by the AIDS prevention adverts and having many friends who died of HIV/AIDS long before there was any treatment for it, left its mark on me.

I will address the points that have been raised as I go along, after which I will try to address any that are not in my speech. There is much to celebrate. The latest UNAIDS figures show an unprecedented pace of progress in the global AIDS response. There are 1 million fewer new HIV infections each year across the world than there were a decade ago, especially among newborn children. We do a lot of work on preventing mother-to-child transmission, which is an obvious stop point, and that work is delivering results. Nearly 10 million people now have access to treatment. Although international assistance remained flat, low and middle-income countries increased funding for HIV, accounting for 53% of all HIV-related spending in 2012. That shows that we are moving towards a lasting response.

That is all excellent news, but, as we debated in Washington last week, we need to put renewed efforts into going the extra mile and achieving an AIDS-free generation. We cannot take our foot off the pedal. Risks remain that might seriously jeopardise the incredible progress we have made. Too many people are still getting infected; 2.3 million were infected last year. As many hon. Members have said, girls and women remain disproportionately affected by the virus. Infection rates in young women are twice as high as in young men. Although tremendous progress has been made on treatment scale-up with the change in the World Health Organisation treatment guidelines in 2013, at least 16 million people who are in need of treatment are not currently receiving it. Stigma and discrimination continue to drive key affected populations underground, which inhibits prevention efforts and increases the vulnerability of those populations to HIV. In 60% of countries there are laws, regulations or policies that block effective HIV services for key populations and vulnerable groups. I will return to that point.

The UK Government were delighted and proud to pledge £1 billion of UK funds at the fourth Global Fund to Fight AIDS, Tuberculosis and Malaria replenishment in Washington last week. The UK pledge alone will save a life every three minutes for the next three years, and it will deliver life-saving antiretroviral therapy for 750,000 people living with HIV. The hon. Member for Strangford (Jim Shannon), who is not in his place and has sent his apologies for having to leave, raised the issue of leverage. The UK contribution helped to leverage, and contributed towards, an unprecedented $12 billion replenishment total. That is 30% more than was pledged at the equivalent event in 2010, and 50% of those funds will go towards dealing with HIV and AIDS.

The UK now calls on all outstanding donors to step up to the plate over the period from 2014 to 2016 to ensure that the target figure of $15 billion is reached and there is maximum impact in terms of lives saved. The Secretary of State and I are telephoning other countries to lobby them. The contribution from one country—I believe it was Switzerland, but I will correct the record if I am wrong—tripled after my telephone call. That is the point of the lobbying effort across the world, which will not end with the pledging in Washington. We must continue that effort to ensure that we reach our targets. We are also working with recipient countries to help them realise increased domestic contributions in the fight against the three diseases. We were delighted by the political commitment of recipient countries at Washington and by the financial commitment of Nigeria, which pledged $1 billion to the national fight against the three diseases. The fight is becoming truly global, with equal partnership and purpose.

This year, we conducted an internal review of our 2011 HIV position paper, which we published last month. I thank STOPAIDS for its help; I see Ben Simms wherever I go in the world. Two years on, DFID is making good progress against its expected results. Treatment-related commitments have already been achieved, and the remaining targets set out in the HIV position paper are on track to be met by 2015.

Several hon. Members mentioned the shift in funding from bilateral to multilateral. Over the past two years, we have been sharpening our focus and working more to our comparative advantage in our bilateral programmes. As the 2011 position paper predicted, the balance between multilateral and bilateral funding has shifted and our bilateral efforts are focused on fewer countries where the need is greatest. The hon. Member for Newcastle upon Tyne North (Catherine McKinnell) asked what we were doing in the programmes where we are shifting the balance of our funding. We now have some exciting new programmes in southern Africa, which is the region hardest hit by the epidemic. Given the urgent need to reduce new infections, we have prioritised critical prevention gaps and we are moving towards complementary work to deal with those gaps. As hon. Members have said, civil society has been, and remains, an essential partner for DFID in addressing those gaps. We are proud to support other multilateral organisations, such as UNAIDS, to ramp up their efforts in the global HIV response. That will reach many more countries, at a much greater scale, than the UK alone could help.

As I have announced, we will increase our annual core contribution to UNAIDS by 50% to £15 million in 2013-14 and 2014-15. That will give the organisation an extra £5 million a year to support its critical role in co-ordinating the world response to HIV and AIDS. In total, our combined bilateral and multilateral contributions secure the UK’s place as a leader in the global HIV response and demonstrate our commitment, in providing a considerable share of total global resources, to universal access to HIV prevention, treatment care and support.

The review paper highlighted three areas of particular focus for the UK: being a voice for key affected populations; renewing efforts on reaching women and girls affected by HIV; and integrating the HIV response with wider health system strengthening, which hon. Members raised, and other development priorities. That includes tackling the structural issues driving the epidemic.

I shall refer to human rights, which many hon. Members raised. In countries with generalised epidemics, HIV prevalence is consistently higher among key affected populations: men who have sex with men; sex workers; transgender people; prisoners; and people who inject drugs. Over the years, DFID has spearheaded support to HIV programmes for key populations. They have been and they will remain a key policy priority for us. We will use DFID’s influence with multilaterals to be a voice for key populations and to push for leadership and investment. We will focus on evidence-based combination prevention services, such as condoms, HIV testing and counselling, and comprehensive harm reduction programmes.

Of particular importance are the programmes and initiatives we are supporting to reduce stigma and discrimination. Our ultimate vision for key populations is for their human rights and health to be recognised, respected and responded to by their Governments. The UK is proud to be a founding supporter of the Robert Carr civil society Networks Fund, through which we support those particularly vulnerable groups. Valuable lessons have been learnt from the fund’s first year and this world AIDS day, the fund announced a second round of grants.

[Pamela Nash]

Before the Minister moves on from the Robert Carr fund and key populations, will she clarify whether any DFID money will go to grass-roots organisations? As I said earlier, the Robert Carr fund operates regionally and I know that a lot of money goes through multilaterals. It would be good to have some clarification on how we are getting money through to smaller groups.

[Lynne Featherstone]

I will come back to that issue shortly.

Human rights was one of the key issues raised by hon. Members. The UK Government are at the forefront of work to promote human rights around the world. We regularly criticise Governments who violate those rights, including those that discriminate against individuals on the basis of sexuality. I have personally raised those issues with Ministers, Prime Ministers and Presidents in Africa. We take some of our lead in DFID bilateral countries from activist groups in the LGBT community, so that may take place behind closed doors due to the difficult, sensitive and dangerous nature of some of the work they do in countries where the law is such that they may face prosecution and for which they could face a backlash. I am committed to raising such issues with Governments across the world, as is the Foreign Secretary and many others across Government. Human rights is at the forefront of our work.

Women and girls are at the centre of our HIV response. Globally, the rate of new HIV infections among women and girls has declined, but the pace of decline is not as rapid as we would like and it is a critical area for renewed UK and global efforts. Gender equality and women and girls’ empowerment lies at the heart of DFID’s development agenda. Since 2011, each of our bilateral programmes has seen a greater focus on HIV prevention addressing the needs of women and girls. We are supporting research to improve outcomes for women and girls, including the development of female-initiated HIV-prevention technologies, and we are looking into how gender inequality drives epidemics, with a particular focus on improving what works for adolescent girls in southern Africa.

We know that in a crisis, girls and women are more vulnerable to rape and transactional sex. The highest maternal mortality and worst reproductive health is in countries experiencing crisis. Contraception, prevention and treatment of HIV and other sexually transmitted infections, and safe abortion are life-saving services, yet they are often ignored in humanitarian responses. That is why DFID is currently developing a new programme on sexual and reproductive health in emergency response and recovery, including services to reduce the transmission of HIV. We welcome the fact that the global health fund will also prioritise women and girls more in 2014 and we look forward to working closely with it on that.

In terms of integration with the wider health system, we know that for a response to be lasting, we must integrate HIV within other sectors and find concrete solutions to sustainable financing. We recognise that a strong health system is an important way to improve the reach, efficiency and resilience of services. The co-infection connection and the integration of HIV services with TB services, sexual and reproductive health services and the wider health system were raised. People living with and affected by HIV, including children and people with disabilities, need to be treated holistically and not just as a series of health problems.

We are also working with countries to ensure that they are in the lead role and increasingly financing their own national responses. In the end, that is the only way to sustainability. We are also working with the global health fund and others to look at market shaping. The hon. Member for Newcastle upon Tyne North mentioned tiered pricing—we term it market shaping—as a way of further reducing commodity prices not only for low-income countries, but for middle-income countries graduating from donor support, which many hon. Members mentioned.

I have tried to cover most of the points raised, but I have left a few things out. Integrated responses to tackling TB-HIV co-infection were highlighted in the HIV position paper review as a key area of current and ongoing effort. It will contribute to the global results to help halve TB-related deaths among people living with HIV by 2015. A cross-Whitehall group on harm reduction was called for. The UK Government remain committed to supporting harm reduction efforts to ensure that that goal gets back on track. DFID is currently liaising with other Whitehall Departments on the drafting of the Commission on Narcotic Drugs ministerial statement, and will remain engaged on that crucial issue in the lead-up to the UN special session on drug control in 2016.

Hon. Members mentioned access to medicines, which is vital. The access to medicines index, last published in November 2012 and supported by DFID, shows that companies have their own strategies for managing their intellectual property and supporting access to medicines. The medicines patent pool currently has agreements with the US National Institutes of Health, Gilead Sciences, ViiV Healthcare and Roche. The UK will continue to support actively that collaborative initiative to enhance access to more affordable treatment and to promote the development of appropriate treatment for children. The UK strongly encourages other companies that have patents for the new first-line treatment for HIV to consider beginning formal negotiations to enter the pool. The medicines patent pool idea was endorsed by the G8 and the UN General Assembly session on HIV and AIDS, to support the availability and development of new first-line treatments for HIV and AIDS.

In addition to funding for antiretroviral drugs through the global health fund, UNITAID and other agencies, DFID also works to make markets for antiretrovirals work better to reduce prices, increase the number of quality suppliers and enhance access. Our partnership with the Clinton Health Access Initiative has already contributed to secure price reductions of almost 50% on both first and second-line therapies for HIV, saving African Governments more than £500 million. That is sufficient to put an extra 500,000 people on AIDS treatment for three years. As has been said, that fall in price from $100,000 per treatment to $100 is the most incredible result. We need to keep pushing down those prices for as long as we can. In terms of civil society, we continue to provide funding for work at the grass roots through our civil society programme partnership arrangements and other DFID civil society grant awarding schemes.

I have only one minute, so I will reply to hon. Members by letter if I have missed any points. The UK and others made huge contributions last week in Washington. There is a great sense of excitement and common purpose in the world, leading towards the vision we all hope for—an AIDS-free generation—an historic moment. A sad truth of the HIV epidemic is that it is often women and girls who are most at risk of human rights abuses in developing countries and least able to get access to the services they need. Addressing gender inequality, stigma, discrimination and legal barriers remains our priority.